AEGiS-15IAC: Clinical profile and outcome of cryptococcal meningitis in Ethiopian AIDS patients treated under local conditions.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Clinical profile and outcome of cryptococcal meningitis in Ethiopian AIDS patients treated under local conditions.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrB1017)

Melaku ZM, Mitikie GM
Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

BACKGROUND: Cryptococcal meningitis is the most common life-threatening fungal infection in patients with AIDS. In Sub-sharan Africa it is one of the commonest opportunistic infections overall. This study was undertaken to assess the clinical profile and management outcome of microbiologically confirmed cryptococcal meningitis in adult Ethiopian AIDS patients treated under local condition.

METHODS: The medical records of all patients admitted to the Department of Internal Medicine, Tikur Anbessa University Hospital (TAUH), Addis Ababa, Ethiopia with the diagnosis of HIV infection and microbiologically confirmed cryptococcal meningitis during the period January 1997 to December 2003 were reviewed.

RESULTS: During the seven-year review period a total of 102 cases of cryptococcal meningitis were admitted to TAUH. The median age was 33.5 years (range 20-70 years; 67 males and 35 females). In 84 of the 102 patients (82.4%) cryptococcal meningitis was the first AIDS defining illness. The main clinical manifestations were headache (99%), fever (97.1%), vomiting (93.1%), and alteration in mentation in (39.1%). Fifty-eight patients (56.9%) had oral candidiasis and tuberculosis as coexisting illnesses. Sixty four patients (62.7%) received antifungal therapy, of these 46 patients (45.1%) received Amphotericin and 18 (17.6%) received fluconazole monotherapy and 40 (39.2%) patients received only palliative care without antifungal therapy. The overall in-hospital mortality rate in this series was 46.2%. Conclusion HIV associated cryptococcal meningitis in Africa is associated with higher mortality than in developed countries. Cryptococcal meningitis under current treatment provided at the TAUH has a high mortality. The current treatment provided to patients at TAUH is sub optimal. There is an urgent need to develop strategies to improve the clinical management of cryptococcal meningitis in resource poor countries in Africa.

Keywords: AEGIS, Meningitis, Cryptococcal, Acquired Immunodeficiency Syndrome, Fluconazole, Amphotericin B, Candidiasis, Oral, HIV Seropositivity, Headache, Opportunistic Infections, Fever, Ethiopia, Africa, Humans, Female, Male, Adult

040711
MoOrB1017